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Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid.

Abstract

BACKGROUND

Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the United States is not known.

OBJECTIVE

This study sought to examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma who are enrolled in Medicaid.

METHODS

Children aged 5 to 19 enrolled in Medicaid in 2009 to 2010 were included. Asthma was defined by at least 1 outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2-year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty, and race/ethnicity on rates of asthma outpatient visits, ED visits, and hospitalizations.

RESULTS

This study included 16,860,716 children (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but it was associated with significantly more asthma-related ED visits and hospitalizations among those with asthma in crude analyses (risk ratio, 1.48; 95% CI, 1.24-1.36; and 1.97; 95% CI, 1.50-1.72, respectively) and when adjusted for race/ethnicity, age, and sex (adjusted risk ratio, 1.23; 95% CI, 1.08-1.15; and 1.62; 95% CI, 1.26-1.43). Residence in urban or poor areas and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma-related ED visits and hospitalizations.

CONCLUSIONS

Residence in poor and urban areas is an important risk factor for asthma morbidity, but not for prevalence, among low-income US children.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: ckeet1@jhmi.edu.

    ,

    Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.

    ,

    Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.

    Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.

    Source

    MeSH

    Adolescent
    Adult
    Ambulatory Care
    Asthma
    Child
    Child, Preschool
    Continental Population Groups
    Emergency Service, Hospital
    Ethnic Groups
    Female
    Hospitalization
    Humans
    Male
    Medicaid
    Morbidity
    Poverty
    Prevalence
    Residence Characteristics
    Risk Factors
    United States
    Urban Population
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    28283418

    Citation

    Keet, Corinne A., et al. "Urban Residence, Neighborhood Poverty, Race/ethnicity, and Asthma Morbidity Among Children On Medicaid." The Journal of Allergy and Clinical Immunology, vol. 140, no. 3, 2017, pp. 822-827.
    Keet CA, Matsui EC, McCormack MC, et al. Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid. J Allergy Clin Immunol. 2017;140(3):822-827.
    Keet, C. A., Matsui, E. C., McCormack, M. C., & Peng, R. D. (2017). Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid. The Journal of Allergy and Clinical Immunology, 140(3), pp. 822-827. doi:10.1016/j.jaci.2017.01.036.
    Keet CA, et al. Urban Residence, Neighborhood Poverty, Race/ethnicity, and Asthma Morbidity Among Children On Medicaid. J Allergy Clin Immunol. 2017;140(3):822-827. PubMed PMID: 28283418.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid. AU - Keet,Corinne A, AU - Matsui,Elizabeth C, AU - McCormack,Meredith C, AU - Peng,Roger D, Y1 - 2017/03/08/ PY - 2016/10/17/received PY - 2017/01/24/revised PY - 2017/01/30/accepted PY - 2017/3/12/pubmed PY - 2017/9/21/medline PY - 2017/3/12/entrez KW - Asthma KW - inner city KW - poverty KW - urbanization SP - 822 EP - 827 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 140 IS - 3 N2 - BACKGROUND: Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the United States is not known. OBJECTIVE: This study sought to examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma who are enrolled in Medicaid. METHODS: Children aged 5 to 19 enrolled in Medicaid in 2009 to 2010 were included. Asthma was defined by at least 1 outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2-year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty, and race/ethnicity on rates of asthma outpatient visits, ED visits, and hospitalizations. RESULTS: This study included 16,860,716 children (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but it was associated with significantly more asthma-related ED visits and hospitalizations among those with asthma in crude analyses (risk ratio, 1.48; 95% CI, 1.24-1.36; and 1.97; 95% CI, 1.50-1.72, respectively) and when adjusted for race/ethnicity, age, and sex (adjusted risk ratio, 1.23; 95% CI, 1.08-1.15; and 1.62; 95% CI, 1.26-1.43). Residence in urban or poor areas and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma-related ED visits and hospitalizations. CONCLUSIONS: Residence in poor and urban areas is an important risk factor for asthma morbidity, but not for prevalence, among low-income US children. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/28283418/Urban_residence_neighborhood_poverty_race/ethnicity_and_asthma_morbidity_among_children_on_Medicaid_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(17)30341-X DB - PRIME DP - Unbound Medicine ER -